摘要
目的：观察重用赤芍治疗乙型肝炎相关性慢加急性肝衰竭的临床疗效。方法：将94例乙型肝炎相关性慢加急性肝衰竭患者随机分为赤芍组30例、清热利湿组32例、西药组32例。西药组只予常规西药综合治疗，清热利湿组则在常规西药综合治疗的基础上加用清热利湿方剂，赤芍组则在常规西药综合治疗的基础上，在清热利湿方剂中加用大剂量赤芍（40～60g）。观察治疗第l周、4周、8周的肝功能f总胆红素（TBil）、谷丙转氨酶（ALT）、谷草转氨酶（AST）、凝血酶原活动度（PTA）1，并记录症状、体征的变化及并发症及临床疗效等情况。结果：临床疗效赤芍组与清热利湿组、西药组比较，差异均有显著性意义（P〈0．05），赤芍组疗效均优于清热利湿组与西药组。清热利湿组与西药组比较，差异无显著性意义（P〉0．05），疗效相仿。3组各生化指标治疗前均处于同一基线水平（P〉0．05）。3组患者治疗第1周后进行两两比较，差异无显著性意义（P〉0．05），表明此时3组疗效相近。治疗4周后3组患者赤芍组PTA上升较清热利湿组显著（P〈0．05），其他检验指标3组间差异无显著性意义（P〉O．05）。治疗8周后赤芍组TBil分别与清热利湿组、西药组比较，差异有显著性意义（P〈0．05）。赤芍组TBil较清热利湿组、西药组消退明显。PTA赤芍组分别与清热利湿组、西药组比较，差异有显著性意义（P〈0．05），赤芍组PTA较清热利湿组、对照组上升明显。3组患者间并发症发生情况两两比较，可知上消化道出血、肝性脑病、肝肾综合征、电解质紊乱、二重感染等并发症发生率均不高，且相互间比较差异无显著性意义（P〉0．05），可能与病例数较少有关。自发性腹膜炎方面，赤芍组与西药组比较，差异有显著性意义（P〈0．05）。胆囊炎方面赤芍组分别与清热利湿组、西药组比较，差异均有显著性意义（P〈0．05）。3组患者经治疗后，赤芍组对二重感染出现后的控制有明显的疗效，有效率为90．91％（10／11），与西药组的33．33％（3／9）比较，差异有显著性意义（P〈0．05），与清热利湿组的50．00％（4／8）比较，差异无显著性意义（P〉0．05）。结论：对于乙型肝炎相关性慢加急性肝衰竭的远期疗效，重用赤芍明显优于一般常规西药治疗及加用清热利湿方的中西结合治疗。
Objective.. To observe the therapeutic effect of large-dose Radix Paeoniae Rubra（Chish~） based on syndrome differentiation and treatment for acute-chronic hepatitis B hepatic failure（ACHBHF）. Methods= Ninety-four ACHBHF cases were randomly divided into Chishao group（n=30）, heat-clearing and dampness-removing herbs group（n=32） and western medicine group（n=32）. All of the three groups were given routine western medicine, additionally, Chishao group was given large-dose Radix Paeoniae Rubra based on syndrome differentiation and treatment, and heat-clearing and dampness-re- moving herbs group was given heat-clearing and dampness-removing herbal recipes. Results- After treatment for one week, hepatic function of the three groups had no difference（P 〉 0.05）. After treatment for 4 weeks, prothrombin activity（PTA） of Chishao group was significantly higher than that of heat-clearing and dampness-removing herbs group（P 〈 0.05）. After 8 weeks, total bilirubin（TBIL） of Chishao group was significantly lower than that of heat-clearing and dampness-removing herbs group and western medicine group（P 〈 0.05）. The increase of PTA of Chish~ group differed from that of other two groups（P 〈 0.05）. Chish~ group showed better effect on controlling the incidence of spontaneous peritonitis and cholecystitis than the other two groups（P 〈 0.05）, but had on significant effect on the incidence of ascites, hepatic encephalopathy, hepatorenalsyndrome, electrolyte disorder, upper gastrointestinal bleeding and dual infection （P 〉0.05）. Chishao group showed better therapeutic effect on dual infection than the western medicine group（P 〈 0.05）, and had better overall therapeutic effect than the other two groups（P 〈 0.05）. Conclusion： Large-dose Radix Paeoniae Rubra based on syndrome differentiation and treat- ment shows better long-term therapeutic effect for acute-chronic hepatitis B hepatic failure than routine western medicine or routine western medicine plus recipes of clearing heat and removing dampness.
出处
《新中医》
CAS
2013年第10期31-34,共4页
New Chinese Medicine
